As recently as 10 years ago, few options for treatment and care were
available to those affected by multidrug-resistant tuberculosis (MDR-TB) and
extensively drug-resistant tuberculosis (XDR-TB).a Later, accumulating evidence
indicated that the programmatic management of M/XDR-TB was not only feasible
but also cost effective. The World Health Organization (WHO) has recognized
M/XDR-TB as a major challenge to be addressed as part of the Stop TB strategy,
launched in 2006. In April 2009, WHO convened a ministerial meeting of
countries with a high burden of MDR-TB in Beijing, China, paving the way in May
2009 for the 62nd World Health Assembly to adopt resolution WHA62.15 on
prevention and control of MDR-TB and XDR-TB, urging Member States to take
action on multiple fronts towards achieving universal access to diagnosis and
treatment of M/XDR-TB by 2015.

Despite the important progress being made, severe bottlenecks are limiting
the response to the M/XDR-TB epidemic. Indeed, only 10% (24 511/250 000) of the
estimated MDR-TB cases among notified TB cases in 2009 in the high MDR-TB
countries, and 11% (30 475/280 000) globally were enrolled on treatment. Some
countries are making progress by implementing policy changes that rationalize
the use of hospitals, such as South Africa, or treating patients through
community-based models of care, such as the Philippines. However, diagnostic
capacity remains limited. Furthermore, the price of some quality-assured
second-line drugs has not fallen, and shortages of drugs still occur. Overall,
there is recognition that the response to MDR-TB must be built across health
systems, and corresponding plans have been made. Human and financial resources
are grossly insufficient and frequently inadequate. If domestic funding is not
urgently mobilized, The Global Fund to Fight AIDS, Tuberculosis and Malaria, as
well as UNITAID, may become the main – if not only – source of
funding for programmatic management of MDR-TB in several countries,
demonstrating that commitment in endemic countries and domestic funding are
hardly mobilized for this public health priority.